OPINION | Limit alcohol supply during pandemic to reduce burden on front-line workers

Easy access to alcohol is convenient and may be comforting, but is it really the best idea during this public health crisis?

Politicians are nervous to impose unpopular restrictions on this recreational drug, says Tim Stockwell

A lineup outside a Yellowknife liquor store on April 9, 2020. Strict physical distancing protocols led to lineups outside both of the city's liquor stores. Professor Tim Stockwell questions the assumption alcohol is essential during this pandemic. (Walter Strong/CBC)

If there was ever a time to take the edge off reality by indulging in a drink or two, surely it is now.

During the COVID-19 pandemic, many governments seem to agree: they have classified the sale of alcohol as an essential service. Liquor stores remain open across much of the North, along with grocery stores, despite the forced closure of, or restrictions on, most other businesses. 

Easy access to alcohol is convenient and may be comforting, but is it really the best idea during this public health crisis?

The stakes for getting alcohol policy right in northern Canada have always been high. Alcohol use in the territories has already imposed a higher cost per person for health care and law enforcement services than in the rest of Canada.

Some jurisdictions, like Greenland and the municipality of Cambridge Bay, Nunavut, have introduced alcohol bans in the interest of public safety.

But last week the N.W.T. government resisted calls from some Indigenous leaders to ban alcohol during the pandemic, asserting this would lead to increased pressure on health-care services to help people going through alcohol withdrawal.

In fact, this is the polar opposite of what would happen. 

Evidence paints different picture

The Canadian Institute for Health Information reports that under normal circumstances alcohol causes more hospital admissions than do heart attacks, and that the territories lead the way here.

In 2015-16, Northwest Territories comfortably led Canada with over 1,300 alcohol-related hospitalizations per 100,000 people aged 12 or older. And this does not include the many more cases partly caused by alcohol — from road crashes, violence, to cancer. Treatment for alcohol withdrawal was a very small proportion of these hospitalizations.

The supply of alcohol burdens health-care services when we can least afford it.- Tim Stockwell

Furthermore, there is strong evidence that the number of people experiencing alcohol withdrawal actually decreases when alcohol supply dries up. Worker strikes at government alcohol monopolies in Canada and Scandinavia show supply reductions led to many fewer presentations to detoxification services

Would a ban only push alcohol dependent drinkers to seek out non-beverage alcohol and illicit drugs? Evidence suggests that when alcohol is unavailable for this population, few cope in these ways and many simply replace alcohol with cannabis — a much safer alternative.

Thus, the supply of alcohol burdens health-care services when we can least afford it. It is unlikely to help with vigilance about physically distancing and other precautions. It has likely contributed to the spike in domestic violence observed in Canada and around the world. Heavy alcohol use can also precipitate or worsen pneumonia, a particular concern for anyone with COVID-19.

Considering all this, should we make a different collective choice? 

At a minimum, restrictions in order

In truth, the supply of alcohol has never been justifiable on health and safety grounds. We demand access to it because it is our favourite recreational drug. Our political leaders know this and are nervous to impose unpopular restrictions on our freedom. They also need the revenue alcohol provides — even if they prefer not to look at the other side of the ledger where the costs outweigh the benefits.

Given that we are most likely not ready for an alcohol ban, even in a pandemic, we urgently need a balanced, evidence-based approach now that allows reasonable access to alcohol, permits local communities to introduce outright bans and offers both treatment and harm reduction services for people with serious alcohol problems (e.g. Managed Alcohol Programs). 

Some Co-op stores in Nunavik have introduced a limit of 12 beers or one litre of wine per customer on Mondays, Wednesdays and Fridays, an example other regions might do well to adopt.

The Canadian Alcohol Policy Evaluation project has already identified effective policies for Canadian governments to reduce alcohol harms: these include introducing minimum prices for alcoholic drinks so it won't be sold below a fixed price, health warning labels, restrictions on irresponsible marketing and sensible limits on availability. It is vitally important that such policies are implemented now to reduce the burden on our heroic health-care and emergency service providers.

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Tim Stockwell is director of the Canadian Institute for Substance Use Research (CISUR) and professor of psychology at the University of Victoria, Canada. He has published over 400 research papers, reports and books on substance use epidemiology and policy. He was a clinician and researcher in the UK before joining Australia's National Drug Research Institute as director. Moving to Canada in 2004 he established the Canadian Institute for Substance Use Research BC (now CISUR) as a multidisciplinary research enterprise investigating the determinants of harmful substance use and also effective harm reduction strategies. He lives in Victoria with his wife Paula and daughters Caitlin and Matilda.